Focal awareness seizures or auras?

Posted by kelspal @kelspal, Apr 13 9:43pm

My daughter has her neurologist thinks are awareness focal seizures. They are very short (5-10 seconds) and happen during stressful situations, when experiencing anxiety, and during and around her menstruation. Her doctor put her in keppra 250 twice a day and it didn't change much. Then it was increased to 500, then 750 and then 1000 mg twice a day. She still has an occasional aura feeling but not sure if its epilepsy. She is having side effects from meds; tired, crabby, etc and does not want to take drugs she may not need. She was going to ask to slowly wean to 750 twice a day and see if there are any changes. Has anyone had a similar situation?

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methel | @methel | Apr 14 11:52am

I’m on extended release Keppra. 1500 mg 2x a day and definitely am more tired, exhausted, sleepy than previously. I seem to be sensitive to the concentration of medicine changes. My seizures would come just when it was time for the next dose. And as my dose slowly was increased, the seizures became less noticeable. So it was definitely an effect of the amount of Keppra I was taking.

adoptivemother | @adoptivemother | Apr 14 9:07am

Hello

I am sorry your daughter is going through this, as is mine. My understanding is that Keppra is typically prescribed for generalized seizures (grand mals) and 1000mg twice a day is a very high dose. Trileptal is an example of a common first line med for partial seizures. There are many others available, however, which do not carry the same reputation for side effects as Keprra. We just took my daughter off of Keppra due to mood issues/suicidality/rage. It is always hard to pin down the cause for such feelings and I often feel like we are playing a guessing game but so far I do believe it was beneficial to remove Keppra.

Something to consider is PNES. I hate when people question if my daughter is "actually" having a seizure yet there is increasing evidence that anxiety and stress particularly when paired with PTSD can cause physiological symptoms that mimic epileptic seizures yet there is no evidence on an EEG. If a high dose of anti-seizure meds isn't working, I would be curious about this.

Has she had an EEG? Are you being seen at Mayo or elsewhere? A Neuro-psychologist might be helpful regardless.

Chris Gautier, Volunteer Mentor | @santosha | Apr 14 7:18am

Hi @kelspal , Good Morning
I also have focal seizures, auras (or simple partial seizures) and complex partial seizures (when your awareness is impacted).
I started to have auras while I was a teenager. They have then evolved to complex partial seizures when one's awareness is impacted.
What does she experience while she has auras? Deja vu episodes, strange smell and taste in the mouth? Those are quite typical during an aura. In case you are interested, I am sending here a link with more details on auras: https://www.epilepsy.com/what-is-epilepsy/seizure-types/focal-onset-aware-seizures.
Stress, anxiety, and menstruation are common triggers to seizures.
Has the doctor told you what kind of epilepsy your daughter has? It would be interesting to know. According to my knowledge, not all kinds of epilepsy have auras. I have temporal lobe epilepsy. My seizures start with auras and can evolve to complex partial seizures or not. I am also on Keppra since last December. I also feel very tired and face other side-effects. But I may not be a reference, as I am very sensitive to anti-convulsant medications.
You also mentioned that your daughter has aura feelings. It seems those are prodromes. Prodrome is a feeling that an aura is on its way. Some people feel it, others do not. I have had prodromes in certain circumstances, before having an aura.
I hope this information helps!
Chris (@santosha)
PS: The Epilepsy Foundation (https://www.epilepsy.com/) has great material on understanding epilepsy, in case you are interested.